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Tuskegee Syphilis Experiment
Tuskegee Syphilis Experiment
The 40-year study was controversial for reasons related to ethical standards. Researchers knowingly failed to treat
patients appropriately after the 1940s validation of penicillin was found as an effective cure for the disease that they were
studying. The revelation in 1972 of study failures by a whistleblower, Peter Buxtun, led to major changes in U.S. law and
regulation on the protection of participants in clinical studies. Now studies require informed consent,[5] communication of
diagnosis, and accurate reporting of test results.[6]
By 1947, penicillin had become the standard treatment for syphilis. Choices available to the doctors involved in the study
might have included treating all syphilitic subjects and closing the study, or splitting off a control group for testing with
penicillin. Instead, the Tuskegee scientists continued the study without treating any participants; they withheld penicillin
and information about it from the patients. In addition, scientists prevented participants from accessing syphilis
treatment programs available to other residents in the area.[7] The study continued, under numerous US Public Health
Service supervisors, until 1972, when a leak to the press resulted in its termination on November 16 of that year.[8] The
victims of the study, all African American, included numerous men who died of syphilis, 40 wives who contracted the
disease, and 19 children born with congenital syphilis.
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The Tuskegee Syphilis Study, cited as "arguably the most infamous biomedical research study in U.S. history",[9] led to the
1979 Belmont Report and to the establishment of the Office for Human Research Protections (OHRP).[10] It also led to
federal laws and regulations requiring Institutional Review Boards for the protection of human subjects in studies
involving them. The Office for Human Research Protections (OHRP) manages this responsibility within the US
Department of Health and Human Services (HHS).[11]
On May 16, 1997, President Bill Clinton formally apologized on behalf of the United States to victims of the experiment.
Contents
History
Study clinicians
Study details
Study termination
Aftermath
Ethical implications
In popular culture
See also
References
Further reading
Primary sources
Secondary sources
External links
History
Study clinicians
For the most part, doctors and civil servants simply did their jobs. Some merely followed orders, others
worked for the glory of science.
— John R. Heller Jr., Director of the Public Health Service's Division of Venereal
Diseases[12]
The venereal disease section of the U.S. Public Health Service (PHS) formed a study group in 1932
at its national headquarters. Taliaferro Clark was credited with founding it. His initial goal was to
follow untreated syphilis in a group of black men for 6 to 9 months, and then follow up with a
treatment phase.[13] When he understood the intention of other study members to use deceptive
practices, Clark disagreed with the plan to conduct an extended study. He retired the year after the
study began.
Although Clark is usually assigned blame for conceiving the Tuskegee Study, Thomas Parran Jr. is
equally, if not more, deserving of originating the notion of a non-treatment experiment in Macon Oliver Wenger
County, Alabama. As the Health Commissioner of New York State (and former head of the PHS
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Venereal Disease Division), Parran was asked by the Rosenwald Fund to make an assessment of their survey and
demonstration projects in six Southern states. Among his conclusions was the recommendation that, "If one wished to
study the natural history of syphilis in the Negro race uninfluenced by treatment, this county (Macon) would be an ideal
location for such a study."[14]
Representing the PHS, Clark had solicited the participation of the Tuskegee Institute (a well-known historically black
college in Alabama, now known as Tuskegee University) and of the Arkansas regional Public Health Service office. Eugene
Heriot Dibble, Jr., an African-American doctor, was head of the John Andrew Hospital at the Tuskegee Institute. (From
1936-1946, he served as director of the Tuskegee Veterans Administration Medical Center, established in 1923 in the city
by the federal government on land donated by the Institute.)
Oliver C. Wenger was the director of the regional PHS Venereal Disease Clinic in Hot Springs, Arkansas. He and his staff
took the lead in developing study procedures. Wenger and his staff played a critical role in developing early study
protocols. Wenger continued to advise and assist the Tuskegee Study when it was adapted as a long-term, no-treatment
observational study after funding for treatment was lost.[15]
Raymond A. Vonderlehr was appointed on-site director of the research program and developed the policies that shaped
the long-term follow-up section of the project. His method of gaining the "consent" of the subjects for spinal taps (to look
for signs of neurosyphilis) was by portraying this diagnostic test as a "special free treatment". Participants were not told
their diagnosis. Vonderlehr retired as head of the venereal disease section in 1943, shortly after the antibiotic penicillin
had first been shown to be a cure for syphilis.
Several African American health workers and educators associated with Tuskegee Institute helped the PHS to carry out its
experimentation and played a critical role in the progress of the study. The extent to which they knew about the full scope
of the study is not clear in all cases. Robert Russa Moton, then president of Tuskegee Institute, and Eugene Dibble, head of
the Institute's John Andrews Hospital, both lent their endorsement and institutional resources to the government study.
Registered nurse Eunice Rivers, who had trained at Tuskegee Institute and worked at its affiliated John Andrew Hospital,
was recruited at the start of the study to be the main contact with the participants in the study.
Vonderlehr advocated for Rivers' participation, as the direct link to the regional African-American community. During the
Great Depression of the 1930s, the Tuskegee Study recruited poor lower-class African Americans, who often could not
afford health care, by offering them the chance to join "Miss Rivers' Lodge". Patients were told they would receive free
physical examinations at Tuskegee University, free rides to and from the clinic, hot meals on examination days, and free
treatment for minor ailments.
Based on the available health care resources, Rivers believed that the benefits of the study to the men outweighed the
risks. As the study became long term, Rivers became the chief person with continuity. Unlike the national, regional and
on-site PHS administrators, doctors, and researchers, some of whom were political appointees with short tenure and
others who changed jobs, Rivers continued at Tuskegee University. She was the only study staff person to work with
participants for the full 40 years. By the 1950s, Nurse Rivers had become pivotal to the study: her personal knowledge of
the subjects enabled maintenance of long-term follow up.
In 1943, Congress passed the Henderson Act, a public health law requiring testing and treatment for venereal disease. By
the late 1940s, doctors, hospitals and public health centers throughout the country routinely treated diagnosed syphilis
with penicillin. However, the Tuskegee experiment continued to avoid treating the men who had the disease.
In the period following World War II, the revelation of the Holocaust and related Nazi medical abuses brought about
changes in international law. Western allies formulated the Nuremberg Code to protect the rights of research subjects. In
1964 the World Health Organization's Declaration of Helsinki specified that experiments involving human beings needed
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the "informed consent" of participants. But no one appeared to have reevaluated the protocols of the Tuskegee Study
according to the new standards and in light of treatment available for the disease which is fatal 8–58% of the time. On July
25, 1972, word of the Tuskegee Study was reported by Jean Heller of the Associated Press; the next day The New York
Times carried it on its front page, and the story captured national attention. Peter Buxtun, a whistleblower who was a
former PHS interviewer for venereal disease, had leaked information after failing to get a response to his protests about
the study within the department. He gave information to the Washington Star and The New York Times. John R. Heller
Jr. of PHS, who in later years of the study led the national division, still defended the ethics of the study, stating, "The
longer the study, the better the ultimate information we would derive."[16] Author James Jones editorialized about Heller,
suggesting that his opinion was, "The men's status did not warrant ethical debate. They were subjects, not patients;
clinical material, not sick people."[17]
Study details
A Norwegian study in 1928 had reported on the pathologic manifestations
of untreated syphilis in several hundred white males. This study is known
as a retrospective study, since investigators pieced together information
from the histories of patients who had already contracted syphilis but
remained untreated for some time.
The Tuskegee study group decided to build on the Oslo work and perform
a prospective study to complement it. Researchers could study the natural
progression of the disease as long as they did not harm their subjects. The
researchers involved with the Tuskegee experiment reasoned that they
Subject blood draw, c. 1953
were not harming the black men involved in the study because they were
unlikely to get treatment for their syphilis and further education would
not diminish their inherent sex drive. Even at the beginning of the study, major medical textbooks had recommended that
all syphilis be treated, as the consequences were quite severe. At that time, treatment included arsenic therapy and the
"606" formula.[18] The researchers reasoned that the knowledge gained would benefit humankind; however, it was
determined afterward that the doctors did harm their subjects by depriving them of appropriate treatment once it had
been discovered. The study was characterized as "the longest non-therapeutic experiment on human beings in medical
history."[7]
The US Public Health Study of Syphilis at Tuskegee began as a 6-month descriptive epidemiological study of the range of
pathology associated with syphilis in the Macon County population. At that time, it was believed that the effects of syphilis
depended on the race of those affected. For African Americans, physicians believed that their cardiovascular system was
more affected than the central nervous system.[19] Initially, subjects were studied for six to eight months and then treated
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Continuing effects of the Stock Market Crash of 1929 and the beginning of
the Great Depression led the Rosenwald Fund to withdraw its offer of
funding. Study directors issued a final report as they thought this might
mean the end of the study once funding to buy medication for the
treatment phase of the study was withdrawn.
Medical ethics considerations were limited from the start and rapidly
deteriorated. The PHS asked black Tuskegee Institute physicians to
participate in the study by offering funds, employment, and interns to
encourage the ongoing participation of the patients. Additionally, the
study intentionally employed Eunice Rivers, a black nurse from Macon
County, to be primary source of contact and build personal, trusting
relationships with patients to promote their participation.[21] To ensure
that the men would show up for the possibly dangerous, painful,
diagnostic, and non-therapeutic spinal taps, the doctors sent the 400
patients a misleading letter titled "Last Chance for Special Free
Treatment". The study also required all participants to undergo an
Table from U.S. Public Health Service
autopsy after death in order to receive funeral benefits. After penicillin
summarising participants in the study
was discovered as a cure, researchers continued to deny such treatment to
many study participants. Many patients were lied to and given placebo
treatments so that researchers could observe the full, long-term progression of the fatal disease.[20]
The Tuskegee Study published its first clinical data in 1934 and issued its first major report in 1936. This was prior to the
discovery of penicillin as a safe and effective treatment for syphilis. The study was not secret since reports and data sets
were published to the medical community throughout its duration.
During World War II, 250 of the subject men registered for the draft. These men were consequently diagnosed as having
syphilis at military induction centers and ordered to obtain treatment for syphilis before they could be taken into the
armed services.[22] PHS researchers attempted to prevent these men from getting treatment, thus depriving them of
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chances for a cure. A PHS representative was quoted at the time saying:
"So far, we are keeping the known positive patients from getting
treatment."[22] Despite this, 96% of the 90 original test subjects
reexamined in 1963 had received either arsenical or penicillin treatments
from another health provider.[23]
Study termination
The first dissent against the Tuskegee study
was Irwin Schatz, a young Chicago doctor
only four years out of medical school. In
1965, Schatz read an article about the study
in a medical journal, and wrote a letter
directly to the study's authors confronting
them with a declaration of brazen unethical
practice.[25] His letter, read by Anne R. Yobs
Peter Buxtun, a PHS
venereal disease (one of the study's authors), was
Group of Tuskegee Experiment test
investigator, the immediately ignored and filed away with a
subjects
"whistleblower" brief memo that no reply would be sent.[26]
In 1968 William Carter Jenkins, an African-American statistician in the PHS, part of the
Department of Health, Education, and Welfare (HEW), founded and edited The Drum, a newsletter devoted to ending
racial discrimination in HEW. The cabinet-level department included the CDC. In The Drum, Jenkins called for an end to
the Tuskegee Study. He did not succeed; it is not clear who read his work.[27]
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Buxtun finally went to the press in the early 1970s. The story broke first in the Washington Star on
July 25, 1972. It became front-page news in the New York Times the following day. Senator Edward
Kennedy called Congressional hearings, at which Buxtun and HEW officials testified. As a result of
public outcry, the CDC and PHS appointed an ad hoc advisory panel to review the study. The panel
found that the men agreed to certain terms of the experiment, such as examination and treatment.
However, they were not informed of the study's actual purpose.[1] The panel then determined the
study was medically unjustified and ordered its termination.
Herman Shaw,
As part of the settlement of a class action lawsuit subsequently filed by the NAACP on behalf of survivor
study participants and their descendants, the U.S. government paid $10 million ($49.6 million in
2017) and agreed to provide free medical treatment to surviving participants and to surviving
family members infected as a consequence of the study; Congress created a commission empowered to write regulations to
deter such abuses from occurring in the future.[28]
A collection of materials compiled to investigate the study is held at the National Library of Medicine in Bethesda,
Maryland.[29]
Aftermath
In 1974 Congress passed the National Research Act and created a commission to study and write regulations governing
studies involving human participants. Within the US Department of Health and Human Services, the Office for Human
Research Protections (OHRP) was established to oversee clinical trials. Now studies require informed consent,[5]
communication of diagnosis, and accurate reporting of test results.[6] Institutional review boards (IRBs), including
laypeople, are established in scientific research groups and hospitals to review study protocols and protect patient
interests, to ensure that participants are fully informed.
In 1994, a multi-disciplinary symposium was held on the Tuskegee study: Doing Bad in the Name of Good?: The Tuskegee
Syphilis Study and Its Legacy at the University of Virginia. Following that, interested parties formed the Tuskegee
Syphilis Study Legacy Committee to develop ideas that had arisen at the symposium. It issued its final report in May
1996.[30] The Committee had two related goals: (1) President Bill Clinton should publicly apologize for past government
wrongdoing related to the study and (2) the Committee and relevant federal agencies should develop a strategy to redress
the damages.[31]
A year later on May 16, 1997, President Bill Clinton formally apologized and held a ceremony at the White House for
surviving Tuskegee study participants. He said:
What was done cannot be undone. But we can end the silence. We can stop turning our heads away. We can
look at you in the eye and finally say on behalf of the American people, what the United States government
did was shameful, and I am sorry ... To our African American citizens, I am sorry that your federal
government orchestrated a study so clearly racist.[32]
Five of the eight study survivors attended the White House ceremony.
The presidential apology led to progress in addressing the second goal of the Legacy Committee. The federal government
contributed to establishing the National Center for Bioethics in Research and Health Care at Tuskegee, which officially
opened in 1999 to explore issues that underlie research and medical care of African Americans and other under-served
people.[33]
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In 2009 the Legacy Museum opened in the Bioethics Center, to honor the hundreds of participants of the Tuskegee Study
of Untreated Syphilis in the Negro Male.[33][34]
The revelations of mistreatment under the Tuskegee Syphilis Study are believed to have significantly damaged the trust of
the black community toward public health efforts in the United States.[35][36] Observers believe that the abuses of the study
may have contributed to the reluctance of many poor black people to seek routine preventive care.[37][36] A 1999 survey
showed that 80% of African American men believe the men in the Tuskegee Syphilis Experiment had been injected with
syphilis.[38] A 2016 paper published by the National Bureau of Economic Research finds "that the historical disclosure of
the [Tuskegee experiment] in 1972 is correlated with increases in medical mistrust and mortality and decreases in both
outpatient and inpatient physician interactions for older black men. Our estimates imply life expectancy at age 45 for
black men fell by up to 1.4 years in response to the disclosure, accounting for approximately 35% of the 1980 life
expectancy gap between black and white men."[36] However, other studies, such as the Tuskegee Legacy Project
Questionnaire, have challenged the degree to which knowledge of the Tuskegee experiments have kept black Americans
from participating in medical research.[39] This study shows that, even though black Americans are four times more likely
to know about the Syphilis trials than are whites, they are two to three times more willing to participate in biomedical
studies.[40] Other studies concluded that the Tuskegee Syphilis trial has played a minor role in the decisions of black
Americans to decline participation as research subjects.[41] Of the studies that have investigated the willingness of black
Americans to participate in medical studies, they have not drawn consistent conclusions related to the willingness and
participation in studies by racial minorities. Some of the factors that continue to limit the credibility of these few studies is
how awareness differs significantly across studies. For instance, it appears that the rates of awareness differ as a function
of method of assessment, study participants who reported awareness of the Tuskegee Syphilis Trials are often
misinformed about the results and issues, and awareness of the study is not reliably associated with unwillingness to
participate in scientific research.[42][43][44][45][46]
Distrust of the government, in part formed through the study, contributed to persistent rumors during the 1980s in the
black community that the government was responsible for the HIV/AIDS crisis by having deliberately introduced the virus
to the black community as some kind of experiment.[47] In February 1992 on ABC's Prime Time Live, journalist Jay
Schadler interviewed Dr. Sidney Olansky, Public Health Services director of the study from 1950 to 1957. When asked
about the lies that were told to the study subjects, Olansky said, "The fact that they were illiterate was helpful, too, because
they couldn't read the newspapers. If they were not, as things moved on they might have been reading newspapers and
seen what was going on."[21]
Ethical implications
Tuskegee highlighted issues in race and science.[48] The aftershocks of this study, and other human experiments in the
United States, led to the establishment of the National Commission for the Protection of Human Subjects of Biomedical
and Behavioral Research and the National Research Act. The latter requires the establishment of institutional review
boards (IRBs) at institutions receiving federal support (such as grants, cooperative agreements, or contracts). Foreign
consent procedures can be substituted which offer similar protections and must be submitted to the Federal Register
unless a statute or Executive Order requires otherwise.
Writer James Jones said that physicians were fixated on African American sexuality, and believing that African Americans
willingly had sexual relations with those who were infected (although none had been told his diagnosis) resulted in their
believing that individuals were solely responsible for contracting the disease.[49] One researcher critiqued how the study
was administered and its change in purpose. He said that it was "the economic exploitation of humans as a natural
resource of a disease that could not be cultivated or animals in order to establish and sustain U.S. superiority in patented
commercial biotechnology".[50]
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Due to the lack of information, the participants were manipulated into continuing the
study without full knowledge of their role or their choices.[51] Since the late 20th
century, IRBs established in association with clinical studies require that all involved in
study be willing and voluntary participants.[52][53]
In popular culture
The lyrics of Gil Scott-Heron's 33-second song, "Tuskeegee #626", featured on the
Bridges (1977) LP, detail and condemn the Tuskegee syphilis experiments.
David Feldshuh wrote a stage play based on the history of the Tuskegee study,
titled Miss Evers' Boys (1992). It was a runner-up for the 1992 Pulitzer Prize in
drama.[54] In 1997 it was adapted as an HBO made-for-TV movie. The HBO
adaptation was nominated for eleven Emmy Awards,[55] and won in four
categories.[56]
Hip hop duo Pete Rock & CL Smooth reference the experiments in the song Depression-era U.S. poster
"Anger in the Nation", from their Mecca and the Soul Brother (1992) LP.
advocating early syphilis
The Tuskegee trials inspired a seven-issue Marvel comic book series, Truth: Red,
treatment. Although
White, and Black (published January – July 2003), written as a prequel to the
Captain America series. Truth: Red, White, and Black explores the exploitation of treatments were available,
certain races for scientific research, as in the Tuskegee syphilis trials.[40] participants in the study did
In the movie Half Baked the character Thurgood Jenkins made reference that his not receive them.
grandfather was in the Tuskegee experiments.
See also
Declaration of Geneva
Declaration of Helsinki
Eugenics in the United States
Guatemala syphilis experiment
Human experimentation in the United States
Human subject research
International Conference on Harmonisation for Registration of Pharmaceuticals
Operation Whitecoat
Nazi human experimentation
Project 4.1
Shiloh Missionary Baptist Church
Unit 731
World Medical Association
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23. Richard A Shweder. "spiked-essays | Essay | Tuskegee re-examined" (http://www.spiked-online.com/articles/0000000
CA34A.htm). Spiked-online.com. Retrieved April 16, 2012.
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43. "Did Tuskegee damage trust on clinical trials?" (https://web.archive.org/web/20080613004659/http://www.cnn.com/20
08/HEALTH/03/17/clinical.trials.ap/index.html). CNN. March 17, 2008. Archived from the original (http://www.cnn.com/
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responsible for race differences in mistrust of medical care?" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC256932
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h.gov/pmc/articles/PMC2377291) . PMID 17901437 (https://www.ncbi.nlm.nih.gov/pubmed/17901437).
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916676-5.
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es/2002/jul/tuskegee/). NPR. Retrieved December 4, 2008.
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Further reading
"Nurse Eunice Rivers" (https://www.msu.edu/course/hm/546/tuskegee.htm). msu.edu.
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"The Tuskegee Syphilis Study and Its Implications for the 21st Century" (http://www.socialworker.com/feature-articles/
ethics-articles/The_Tuskegee_Syphilis_Study_and_Its_Implications_for_the_21st_Century/). socialworker.com.
"Tuskegee Syphilis Study article" (http://www.encyclopediaofalabama.org/face/Article.jsp?id=h-1116). Encyclopedia of
Alabama.
"Tuskegee re-examined by Richard A Shweder, Cultural anthropologist (sp!ked article)" (http://www.spiked-online.co
m/newsite/article/14972#.WbRMANFGnIV).
Primary sources
Caldwell, J. G; E. V. Price; et al. (1973). "Aortic regurgitation in the Tuskegee study of untreated syphilis". J Chronic
Dis. 26 (3): 187–94. doi:10.1016/0021-9681(73)90089-1 (https://doi.org/10.1016/0021-9681%2873%2990089-1).
PMID 4695031 (https://www.ncbi.nlm.nih.gov/pubmed/4695031).
Hiltner, S. (1973). "The Tuskegee Syphilis Study under review". Christ Century. 90 (43): 1174–6. PMID 11662609 (htt
ps://www.ncbi.nlm.nih.gov/pubmed/11662609).
Kampmeier, R. H. (1972). "The Tuskegee study of untreated syphilis". South Med J. 65 (10): 1247–51.
doi:10.1097/00007611-197210000-00016 (https://doi.org/10.1097/00007611-197210000-00016). PMID 5074095 (http
s://www.ncbi.nlm.nih.gov/pubmed/5074095).
Kampmeier, R. H. (1974). "Final report on the "Tuskegee syphilis study". South Med J. 67 (11): 1349–53.
doi:10.1097/00007611-197411000-00019 (https://doi.org/10.1097/00007611-197411000-00019). PMID 4610772 (http
s://www.ncbi.nlm.nih.gov/pubmed/4610772).
Olansky, S.; L. Simpson; et al. (1954). "Environmental factors in the Tuskegee study of untreated syphilis" (https://ww
w.ncbi.nlm.nih.gov/pmc/articles/PMC2024316). Public Health Rep. 69 (7): 691–8. doi:10.2307/4588864 (https://doi.or
g/10.2307/4588864). PMC 2024316 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2024316) . PMID 13177831 (htt
ps://www.ncbi.nlm.nih.gov/pubmed/13177831).
Rockwell, D. H.; A. R. Yobs; et al. (1964). "The Tuskegee Study of Untreated Syphilis; the 30th Year of Observation".
Arch Intern Med. 114: 792–8. doi:10.1001/archinte.1964.03860120104011 (https://doi.org/10.1001/archinte.1964.038
60120104011). PMID 14211593 (https://www.ncbi.nlm.nih.gov/pubmed/14211593).
Schuman, S. H.; S. Olansky; et al. (1955). "Untreated syphilis in the male negro; background and current status of
patients in the Tuskegee study". J Chronic Dis. 2 (5): 543–58. doi:10.1016/0021-9681(55)90153-3 (https://doi.org/10.1
016/0021-9681%2855%2990153-3). PMID 13263393 (https://www.ncbi.nlm.nih.gov/pubmed/13263393).
Photocopied documents from the study
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The Tuskegee Study Document from Draft report of study Draft report of study
Group Letter inviting Tuskegee Syphilis results up to 1949, page results up to 1949, page
subjects to receive Study, requesting that 1 2
"special treatment", after test subjects die,
actually a diagnostic an autopsy be
lumbar puncture performed, and the
results sent to the
National Institutes of
Health
Secondary sources
Gjestland T (1955). "The Oslo study of untreated syphilis: an epidemiologic investigation of the natural course of the
syphilitic infection based upon a re-study of the Boeck-Bruusgaard material". Acta Derm Venereol. 35 (Suppl 34): 3–
368.
Gray, Fred D. (1998). The Tuskegee Syphilis Study: The Real Story and Beyond. Montgomery, Alabama: NewSouth
Books.
Jones, James H. (1981). Bad Blood: The Tuskegee Syphilis Experiment. New York: Free Press.
The Deadly Deception, by Denisce DiAnni, PBS/WGBH NOVA documentary video, 1993. (http://www.lib.unc.edu/hou
se/mrc/films/full.php?film_id=6341)
Reverby, Susan M. (1998). "History of an Apology: From Tuskegee to the White House". Research Nurse.
Reverby, Susan M. (2000). Tuskegee's Truths: Rethinking the Tuskegee Syphilis Study. University of North Carolina
Press.
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Reverby, Susan M. (2009). Examining Tuskegee: The Infamous Syphilis Study and its Legacy. University of North
Carolina Press.
Thomas, Stephen B; Sandra Crouse Quinn (1991). "The Tuskegee Syphilis Study, 1932–1972: Implications for HIV
Education and AIDS Risk Programs in the Black Community" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC140566
2). American Journal of Public Health. 81 (1503): 1498–1505. doi:10.2105/AJPH.81.11.1498 (https://doi.org/10.2105/
AJPH.81.11.1498). PMC 1405662 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1405662) . PMID 1951814 (http
s://www.ncbi.nlm.nih.gov/pubmed/1951814).
Carlson, Elof Axel (2006). Times of triumph, times of doubt : science and the battle for the public trust. Cold Spring
Harbor Press. ISBN 0-87969-805-5.
Washington, Harriet A. (2007). Medical Apartheid: The Dark History of Medical Experimentation on Black Americans
From Colonial Times to the Present.
External links
Bad Blood: The Tuskegee Syphilis Study (http://www.hsl.virginia.edu/historical/medical_history/bad_blood/index.cfm).
Claude Moore Health Sciences Library, University of Virginia.
"Patient medical files" (https://www.archives.gov/southeast/finding-aids/tuskegee.html). National Archives and
Records Administration Southeast Region. Morrow, GA.
"Review of the TSS" (http://www.msu.edu/course/hm/546/tuskegee.htm). msu.edu.
"U.S. Public Health Service Syphilis Study at Tuskegee" (https://www.cdc.gov/tuskegee/). Center for Disease Control.
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